Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

1106 Abstracts 60575-60579

12th World AIDS Conference

Project: Patient's knowledge and self-efficacy are key components to HIV drug
compliance. A Protease Inhibitor Support Group was developed and implemented
for patients scheduled to begin therapy with a protease inhibitor at the Orange
County Health Care Agency in Santa Ana, California. The initial support group
included a pre-and post-test assessment and a 90 minute support group. The
assessment consisted of questions on HIV medication knowledge as well as
self efficacy issues. The support group consisted of patient discussions, formal
education, and a question and answer session. The support group was facilitated
by a health educator, a nurse, and a nutritionist. Written educational materials
were also provided. Additional follow-up seminars are offered monthly to provide
continued support.
Results: The Protease Inhibitor Support Group has been successful with patients at the Orange County Health Care Agency. Positive feedback has been
received in both verbal and written form. Analysis of pre- and post-test assessment scores show that participants have extremely high beliefs that they can
successfully take medication. However, pre-test scores demonstrated a medication knowledge deficit. Patient knowledge increased after the support group.
Comparison of pre-and post-test scores show a statistically significant improvement in knowledge (Wilcoxon signed rank test, p-value <.001).
Lessons Learned: Patients are accepting of a protease inhibitor support group.
Participants had high self-efficacy and with this support group they gained the
knowledge to achieve their goals.
60575 Is Staphylococcus aureus colonization related to the
clinical parameters of the HIV infection? A preliminary
report
Helen Sambatakou1, E.J. Giamerellos-Bourboulis2, J. Stephanou1,
H. Giamarellou2, P. Gargalianos1. 1 Department of Special Infections, Athens
General Hospital "G. Gennimatas", Mesogeion, 154, Athens 11527; 2Athens
Medical School, Athens, Greece
Objective: S. aureus is a common cause of bacterial infections in HIV(+) individuals (J. Chemother 1995, 7Suppl. 3: 19) and methicillin-resistant (MRSA) isolates
are connected to infections with high case-fatality. The present study focused on
the impact of the colonization by S. aureus on the physical history of the HIV
infection.
Patients & Methods: Nasal swabs were collected from 168-152 male and 16
female- HIV(+) individuals, cultured onto Chapman's medium and incubated for
48 h at 30 C. Identification of microorganism was based on the positive catalase
and coagulase test. Resistance to methicillin was determined after subculturing
single colonies onto Mueller-Hinton agar enriched with 6 plg/ml of oxacillin and
4% NaCI for 18 h at 37 C. Results were correlated to CD4(+) cell count, disease
stage and current history of a bacterial infection.
Results: S. aureus carriage was identified in 2 out of 19 individuals with >500
CD4(+)//i1 (10.5%), in 20 out of 64 with 200-500 CD4(+)//i (31.3%) and in 25
out of 75 with <200 CD4(+)/II (33.3%) and in 20 out of 49 (40.8%) C3 stage
patients. From the above isolates 0 (0%), 9 (45%), 16 (64%) and 14 (70%)
respectively were MRSA. S. aureus carriage was also detected in 15 out of
31 presenting with acute or chronic sinusitis whereas from the C3-carriers one
died from staphylococcal bacteraemia, one presented with cellulitis and two with
furunculosis.
Conclusions: S. aureus carriage in HIV(+) individuals a) is higher in those
with <500 CD4(+)//l and in those at C3 stage of infection, b) is connected to
the occurrence of bacterial infections, and c) is caused by MRSA strains leading
the clinician empirically to avoid /--lactams for the management of staphylococcal
infections.
S60576 Improved survival in HIV/AIDS patients treated with
aggressive combination antiretroviral therapy
Clayton Barbour. Desert AIDS Project 750 South Vella Road Palm Springs,
California 92264, USA
Objective: Retrospective evaluation of morbidity, mortality, and resource utilization statistics of patients treated at a community HIV health clinic utilizing
aggressive combination antiretroviral therapy.
Population: Approximately 1000 HIV seropositive or AIDS patients. Population heavily weighted towards more advanced disease with approximately 50%
of patients with CD 4 T Lymphocyte count <200.
Methods: All patients with CD 4 Lymphocyte counts <500 regardless of HIV
Viral load were offered triple drug therapy. Patients with CD 4 Lymphocyte counts
>500, and viral loads >10,000 were offered triple drug therapy. Patients were
counseled regarding the importance of strict adherence to the prescribed medications. Viral loads were assessed at 4 weeks after initiating therapy, and then
followed every 8 weeks until the viral load fell below the level of detection (<400
copies/ml HIV-RNA by PCR). Once sufficient viral suppression was obtained the
CD 4 lymphocyte counts, and HIV-RNA viral loads were followed every 12 weeks.
Records were reviewed for the past 4 years with attention to disease progression,
opportunistic infections, skilled home nursing care, hospitalizations, and deaths.

Results: Aggressive management has resulted in a significant reduction in HIV
viral load, with 72% of patient achieving undetectable viral loads. The majority
of patients achieved a corresponding improvement in CD 4 lymphocyte counts.
Review of the records reveals a 70% reduction or opportunistic infections, 55%
reduction in hospitalizations, 66% reduction in utilization of home care for skilled
nursing visits, and 75% reduction in the number of deaths.

Conclusion: Experience at this institution indicates that aggressive treatment
with close follow-up can result in a substantial improvement in quality of life,
increased longevity, and reduce overall cost of care. Principle reasons for failure
were inability to construct a drug regimen including three new antiretrovirals,
non-adherence to medications secondary to substance abuse, inability to adhere
secondary to frequency of dosing, and excessive adverse side effects limiting
tolerance to medications.
605771 Identifying best practices, as the armed forces and other
uniformed services respond to the HIV/AIDS epidemic
Norman Nees Miller. 4 West Wheelock Street Hanover, New Hampshire 037555,
USA
Issues: The armed forces and other uniformed services (peacekeeping forces,
police, prison services and prisoners, and the merchant maritime sector), and
their families, are population groups at special risk for HIV transmission. They
constitute groups often outside the mainstream National AIDS Programmes, NAP
management committees and national surveillance/reporting systems.
Project: The Civil-Military Alliance to Combat HIV and AIDS was established after the Berlin World AIDS Conference in 1993 to pursue a world-wide programme
of advocacy for more vigorous HIV prevention education and training within these
various uniformed services, and to promote greater integration and collaboration
between the National AIDS Programmes and these specialized sectors.
Results: The regional seminars organized by the Civil-Military Alliance for
defence officials, military commanders and leaders of military and national (civil)
AIDS programme attracted over 600 participants from over 80 countries. Training
and military AIDS programme development, the designation of military programme
co-ordinators, greater integration with the civilian programme at all levels, policy
reform, military-to-military technical cooperation - these are among the key outcomes of this effort spanning over 4 years. Programme development in maritime
and prison sectors is recent and still in early days.
Lessons Learned: Military, maritime and prison officials are addressing the
critical interface with the general population and the sex worker population, recognizing the need for risk reduction, harm reduction and peer education, and
renewing their attention to mandatory testing, military codes of conduct, and the
potential for enhancing impact through the formation of regional networks and
cooperation.
|60578 Decreased healthcare utilization costs with increased
use of protease inhibitors in HIV+ patients
John D. Stansell1 2, D. Daly3, E. Hamel3, D. Lapins3. 1San Francisco General
Hospital, San Francisco, CA 94110; 2UCSF AIDS Program at San Fran General,
San Francisco CA; 3Clinical Partners, San Francisco CA, USA
Objectives: To assess the effect of increased use of protease inhibitors (PIs) on
overall healthcare utilization costs in HIV+ patients.
Design: Blinded retrospective third-party claims review and chart audit.
Methods: Data were collected from paid-claims insurance forms on use of PIs
in 1996 and 1997 in 2336 HIV+ patients in 5 US regions (2 Western regions,
Northwest, Southwest and Southeast). Forms were from HMO, fee-for-service,
and PPO claims. Patients were classified by PI history and time since initiation of
PI: (1) <1 year, (2) >1 year, or (3) not on PI. Costs per patient per month (PPPM)
were compared by year, for each region and the group as a whole, in terms of
cost of oral medications, professional fees, home healthcare, and hospitalization.
PI use was also correlated with incidence of opportunistic infections (Ols): pneumocystis carinii pneumonia (PCP), Mycobacterium avium complex (MAC), and
cytomegalovirus (CMV).
Results: Between 1996 and 1997, PI use increased from 37% to 53% of the
total population. For each 10% rise in PI use, there was a $76 increase PPPM
in cost of oral medications but a $218 decrease in other costs (overall decrease:
$142 PPPM). Costs decreased in all regions as PI use increased and tended to
be lower where PI use was higher. PCP incidence fell from 5% to 1.9% (64%
decrease). If PCP did occur, the cost of treating it was 40% lower in a PI than in
a non-PI patient; costs were lowest in those taking PIs for >1 yr. MAC incidence
decreased from 0.53% to 0%. CMV incidence, after falling markedly from 1995
to 1996, rose slightly, from 0% to 0.46%.
Conclusion: Increased PI use correlates with a large drop in total cost of treatment of HIV+ patients despite increased initial cost of oral medications. Increased
PI use also correlates with a significant improvement in outcome as measured by
a decreased incidence of Ols.
1605791 A comparison of HIV+ men and women:
Neuropsychological findings and psychological
co-factors
Ann Pirolli1, David Burdge1, E. Strauss2. 1Oak Tree Clinic and the University of
British of Columbia, Oak Tree Clinic B4, 4500 Oak Street, Vancouver, British
Columbia V6H 3N1; 2University of Victoria, Victoria, BC, Canada

Background: To explore the interaction of HIV infection, stress, and gender
on the neuropsychological profile of HIV+ men and women versus non-infected
controls. We hypothesized: 1) a subset of HIV+ subjects would demonstrate mild
impairment in certain cognitive areas; 2) measurable levels of stress would be
related to neuropsychological impairment; and 3) HIV+ women would experience